Breast Cancer - Adjuvant Systemic Therapy

A. Mortality from breast cancer results from systemic spread of disease prior to local treatment.

B. Axillary node involvement and certain features of the primary tumor can be used to predict risk of occult distant spread.

C. Meta-analysis of all published trials of adjuvant breast cancer treatment was performed in 1990; approximately 30,000 women had received tamoxifen and 9,000 received chemotherapy in this analysis (Lancet 1992;3391:1-5,71-85).

1. Chemotherapy produced a statistically significant reduction in recurrence and in mortality in women up to age 59.
2. Tamoxifen produced statistically significant reduction in recurrence and in mortality in women 40 and older.
3. The benefits observed for both forms of adjuvant therapy were greater during years 6-10 of follow-up than during the first 5 years.
4. The proportional reduction in recurrence and in mortality for both tamoxifen and chemotherapy was constant across all nodal subsets (0, 1-3, 4 or more positive nodes).

D. One half of all women with breast cancer are node negative; the overall survival in this group is approximately 70% at 10 years.

1. 1. Prognostic factors which suggest and adverse outcome in node negative women include larger tumors, high nuclear grade, vascular or lymphatic invasion, high mitotic activity (high S phase).

E. All node positive and most node negative women receive adjuvant therapy.